title: Safety of the Manchester Triage System to identify less urgent patients in paediatric emergence care: a prospective observational study.
abstract: OBJECTIVE
  To assess hospitalisation rate as a proxy for the ability of the Manchester Triage System (MTS) to identify less urgent paediatric patients. We also evaluated general practitioner (GP) services to determine if they met patients' needs compared to emergency department care.
  
  
  METHODS
  Self-referred children triaged as less urgent by the MTS in two emergency departments in the Netherlands were included in a prospective observational study. Therapeutic interventions during emergency department consultation, hospitalisation after consultation and determinants for hospitalisation were assessed using logistic regression analysis.
  
  
  RESULTS
  During emergency department consultation, extensive therapeutic interventions were performed more often in patients with extremity problems (n=175, 19%) and dyspnoea (n=30, 15%). 191 (3.5%) of 5425 patients were hospitalised. Age and presenting problem remained statistically significant in multivariable logistic analysis, predicting hospitalisation with ORs of 3.0 (95% CI 2.2 to 4.1) for age <1 year, 2.5 (1.5 to 4.1) for dyspnoea, 3.5 (2.5 to 4.9) for gastrointestinal problems and 2.8 (1.1 to 7.2) for patients with fever without identified source compared to all other patients. 3975 (76%) of 5234 patients were contacted for follow-up after discharge. Six (0.15%) patients were hospitalised after emergency department discharge.
  
  
  CONCLUSIONS
  In the MTS less urgent categories, overall hospitalisation is low, although children <1 year of age or with dyspnoea, gastrointestinal problems or fever without identified source have an increased risk for hospitalisation. Except for these patient groups, the MTS identifies less urgent patients safely. It may not be optimal for GP services to treat patients with extremity problems.
authors.affiliation: Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: van Veen
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Lizanne
authors.initials: L
authors.lastname: Lettinga
authors.forename: Madelon
authors.initials: M
authors.lastname: Ruige
authors.forename: Alfred H J
authors.initials: AH
authors.lastname: van Meurs
authors.forename: Johan
authors.initials: J
authors.lastname: van der Lei
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D004812:Epidemiologic Methods; D005260:Female; D006302:Health Services Research / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands; D010351:Patient Discharge; D012017:Referral and Consultation; D014218:Triage / Q000458:organization & administration / Q000592:standards*